Older patients with proximal femur fractures and SARS-CoV-2 infection – An observational study
Background: Older patients are at increased risk of severe COVID-19 infection and associated mortality. There are limited data evaluating the outcome of older patients with hip fractures treated during the COVID-19 pandemic, and it has been suggested that these patients should be treated non-operatively due to high mortality risk. The aim of this study was to report the outcomes of COVID-19 infected hip fracture patients treated at a single centre. Methods: This was a retrospective cohort study. Data were collected from February 2020 (after the first confirmed COVID-19 infected patient was reported in the Midlands region of the UK). All patients admitted to the hospital with femoral neck fractures were included. Patient demographics, comorbidity, COVID-19 status, and short-term clinical outcomes were obtained by review of electronic medical records. The outcomes of COVID-19 infected patients were compared with non-COVID-19 patients treated during the study period. Results: Twenty-nine patients were included (mean age of 80 years), of whom 14 (48%) were tested positive for COVID-19 infection in the postoperative period. Overall, 26 patients (90%) underwent surgical treatment. COVID-19 infected patients had significantly higher Charlson comorbidity scores compared to the control group (5 vs. 4; p = 0.047). Only 5 COVID-19 infected patients (36%) required supplemental oxygen therapy in the postoperative period, and no patients required respiratory or other organ support. The 30-day mortality rate in COVID-19 patients was 14% compared to 0% in the negative controls (p = 0.22). Interpretation: COVID-19 infection did not increase the mortality rate of older patients undergoing surgery for hip fractures during the pandemic. The authors recommend careful assessment of patient fitness and prompt surgical treatment. In addition, it was noted that nearly all admissions were either given large boluses of Vitamin D or were on maintenance supplementation, which may have affected the severity of the response to COVID-19 infections.
Authors contribution AB, VB, and SM shared the idea for and designed the study. AB and VB collected the data. All named authors had full access to all the data. AB drafted the manuscript. RPS did the analysis and all authors critically revised the manuscript for important intellectual content and gave approval for the final version to be published.
Transparency declaration The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Conflict of interest AB certifies that he or she has no financial conflict of interest (e.g., consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) in connection with this article. VB certifies that he or she has no financial conflict of interest (e.g., consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) in connection with this article. SM certifies that he or she has no financial conflict of interest (e.g., consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) in connection with this article. RPS certifies that he or she has no financial conflict of interest (e.g., consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) in connection with this article.
Ethical approval Ethical approval was..
Alipio, Vitamin D supplementation could possibly improve clinical outcomes of patients infected with Coronavirus
Aw, Silva, Palmer, Immunosenescence: emerging challenges for an ageing population, Immunology
Brown, ICU" risk -20-fold greater in the Vitamin D Deficient. BAME, African Americans, the Older, Institutionalised and Obese, are at greatest risk. Sun and "D"-supplementation -Game-changers? Research urgently required, BMJ
Burahee, Barry, Sutcliffe, Mahroof, Older patients with proximal femur fractures and SARS-CoV-2 infection -An observational study, SICOT-J
Burahee, None, SICOT-J
Catellani, Coscione, 'ambrosi, Usai, Roscitano et al., Treatment of proximal femoral fragility fractures in patients with COVID-19 during the SARS-CoV-2 outbreak in Northern Italy, JBJS
Chen, Zhou, Dong, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study, Lancet
Darowski, The care of patients with fragility fracture
Du, Liang, Yang, Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study, Eur Respir J
Guan, Ni, Hu, Liang, Ou et al., Clinical characteristics of coronavirus disease 2019 in China, N Engl J Med
Johnston, West Midlands emerges as coronavirus hotspot
Lei, Jiang, Su, Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection, EClinicalMedicine
Mehta, Mcauley, Brown, Sanchez, Tattersall et al., COVID-19: consider cytokine storm syndromes and immunosuppression, The Lancet
Mi, Chen, Xiong, Xue, Zhou et al., Characteristics and early prognosis of COVID-19 infection in fracture patients, J Bone Joint Surg. American Volume
Salar, Baker, Forward, Predictors of direct home discharge following fractured neck of femur, Ann R Coll Surg Engl
Sutherland, Cook, Miller, Older patients are immunocompromised by cytokine depletion and loss of innate immune function after HIP fracture surgery, Geriatr Orthop Surg Rehabil
Vester, Huber-Lang, Kida, Scola, Van Griensven et al., The immune response after fracture trauma is different in old compared to young patients, Immun Ageing
Wang, Hu, Hu, Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, JAMA